Venofer (J1756) cost and reimbursement per dose

$0.227 per mg is Part B's ASP+6% rate for Q3 2026. Medicare pays J1756 per 1 mg billing unit, not per vial or per dose — a 10 mg-per-unit drug needs a conversion step first; this one doesn't, units equal the ordered mg directly. On the default 200 mg dose that is $45.40 for the drug, and the administration line (96374, $37.74) is 45% of the $83.14 allowed amount — nearly as large as the drug itself. Full administration code reference: IV push codes 96374–96376 → and IV infusion codes 96365–96366 →. Full explanation: How Medicare Part B drug cost sharing works →

What a full 1,000 mg course costs

Every Venofer regimen runs to a 1,000 mg cumulative course, not an open-ended schedule. The NDD-CKD course — 200 mg on 5 different days — is 5 separate claims, each with its own 96374 administration line:

Administration is 45% of the course total, the same share it is on a single visit — it does not shrink as a proportion of the bill as the course runs. A denied or downcoded 96374 line on any one of the five visits loses the practice nearly as much as a pricing error on the drug line itself.

Since January 1, 2011, the Medicare End-Stage Renal Disease Prospective Payment System has paid the dialysis facility one bundled per-treatment rate that covers renal-related items, including IV iron. The 100 mg hemodialysis dose is the commonest clinical use of Venofer, and it is the one setting where the drug is usually not separately billable to Part B:

Because the commonest use of this drug cannot be billed to Part B at all, the estimator above defaults to the 200 mg NDD-CKD dose rather than the 100 mg HDD-CKD dose — that is the regimen a practice can legitimately price against Part B. Confirm the dialysis setting before submitting any J1756 claim.

For a 200 mg dose (200 units) with the 96374 IV push code, Medicare allows $83.14, and the Part B coinsurance on that is $16.63. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met; Plan K leaves $8.31 and Plan L $4.16. Those are small numbers, and on this drug they are the wrong ones to look at.

The whole claim is smaller than the deductible. At $83.14 against $283, a patient who has not yet met their Part B deductible for the year pays the entire claim — and does so on eight of the ten plans, because only C and F cover the Part B deductible, and both are closed to anyone newly eligible after 2020. Across the five-visit, 1,000 mg course the first three visits cost the full $83.14, the fourth costs $43.49 and only the fifth costs the $16.63 this table is built on. The patient pays $309.54 for the course, of which $283 is deductible and $26.54 is coinsurance.

That inverts what Medigap is worth here. On a drug where one claim runs to thousands, a plan that covers the coinsurance is the difference between a large bill and none. On Venofer the coinsurance is $26.54 across an entire course, so the plan letter barely matters and the deductible decides almost everything — which is also why the month of the year a course starts changes the bill more than the plan does. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Commercial payers negotiate their own rate for J1756, not ASP+6% — Aetna's median published rate is about $0.23 per mg, close to Medicare's $0.227, putting a 200 mg dose at about $46.00 before benefits. Full explanation: How commercial drug reimbursement works →

Normalized to 1,000 mg of elemental iron, Q3 2026 ASP+6%:

A 12x spread separates the cheapest and most expensive products in this class for the same 1,000 mg of iron. Labeled courses differ in the number of visits — Injectafer is dosed 750 mg twice, Feraheme 510 mg twice (a 1,020 mg course), Monoferric a single 1,000 mg dose — so the number of administration claims differs too, which is exactly why the cheapest per-mg product is not automatically the cheapest course. This table compares Medicare allowed amounts only; it is not a clinical recommendation, and no product here is more or less clinically appropriate than another based on price alone.

American Regent runs one program for Venofer: AR Assist, a free-drug program for patients who are uninsured or have a coverage gap. There is no manufacturer copay card for commercially insured patients and no diagnosis-matched foundation fund open today. Full assistance program details →

D63.1 (Anemia in chronic kidney disease) is the load-bearing diagnosis code — payer policies want it as primary or secondary, and a CKD stage code alone triggers denial. Stage and dialysis-status codes pair with it: N18.4 (CKD stage 4), N18.5 (CKD stage 5), N18.6 (end stage renal disease), and Z99.2 (dependence on renal dialysis, pairing with N18.6). Off-label, non-CKD iron-deficiency anemia bills D50.0, D50.8 or D50.9.

N18.3 is not a billable code. CKD stage 3 bills as N18.30 (unspecified), N18.31 (stage 3a) or N18.32 (stage 3b).